Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis

Abstract

PURPOSE Fear of cancer recurrence (FCR) is a significantly distressing problem that affects a substantial number of patients with and survivors of cancer; however, the overall efficacy of available psychological interventions on FCR remains unknown. We therefore evaluated this in the present systematic review and meta-analysis. METHODS We searched key electronic databases to identify trials that evaluated the effect of psychological interventions on FCR among patients with and survivors of cancer. Controlled trials were subjected to meta-analysis, and the moderating influence of study characteristics on the effect were examined. Overall quality of evidence was evaluated using the GRADE system. Open trials were narratively reviewed to explore ongoing developments in the field (PROSPERO registration no.: CRD42017076514). RESULTS A total of 23 controlled trials (21 randomized controlled trials) and nine open trials were included. Small effects (Hedges’s g) were found both at postintervention ( g = 0.33; 95% CI, 0.20 to 0.46; P < .001) and at follow-up ( g = 0.28; 95% CI, 0.17 to 0.40; P < .001). Effects at postintervention of contemporary cognitive behavioral therapies (CBTs; g = 0.42) were larger than those of traditional CBTs ( g = 0.24; β = .22; 95% CI, .04 to .41; P = .018). At follow-up, larger effects were associated with shorter time to follow-up (β = −.01; 95% CI, −.01 to −.00; P = .027) and group-based formats (β = .18; 95% CI, .01 to .36; P = .041). A GRADE evaluation indicated evidence of moderate strength for effects of psychological intervention for FCR. CONCLUSION Psychological interventions for FCR revealed a small but robust effect at postintervention, which was largely maintained at follow-up. Larger postintervention effects were found for contemporary CBTs that were focused on processes of cognition—for example, worry, rumination, and attentional bias—rather than the content, and aimed to change the way in which the individual relates to his or her inner experiences. Future trials could investigate how to further optimize and tailor interventions to individual patients’ FCR presentation.

Development and usability evaluation of an online self‐management intervention for fear of cancer recurrence (iConquerFear)

“…A meta‐analysis of 23 controlled trials found that psychological interventions for FCR are efficacious following treatment (Hedges g = 0.33) and at follow‐up ( g = 0.30) . However, available internet/telephone interventions ( g = 0.10) were less effective than those delivered face to face ( g = 0.38).…”

Fear of cancer recurrence promotes cancer screening behaviors among family caregivers of cancer survivors

“…To the best of our knowledge, the majority of prior FCR research has been grounded in the assumption that FCR is primarily linearly related to poor psychological outcomes (eg, depression, anxiety), and therefore reducing FCR is important for improving these outcomes. 37 This assumption holds when considering the current study data regarding age-appropriate breast cancer screening maintenance, in which a high FCR was found to negatively affect a women's age-appropriate engagement with breast cancer screening. Conversely, the data from the current study regarding colorectal cancer screening and prostate cancer screening suggested that FCR motivates some healthy behaviors as well.…”

“…The findings also suggested that the role of FCR in repeated breast cancer screening behaviors that are age‐appropriate differs from that in screening for colorectal or prostate cancer. To the best of our knowledge, the majority of prior FCR research has been grounded in the assumption that FCR is primarily linearly related to poor psychological outcomes (eg, depression, anxiety), and therefore reducing FCR is important for improving these outcomes . This assumption holds when considering the current study data regarding age‐appropriate breast cancer screening maintenance, in which a high FCR was found to negatively affect a women's age‐appropriate engagement with breast cancer screening.…”

Nachsorge in der gynäkologischen Onkologie

“…Die Angst vor Rezidiven gehört zu den häufigsten und subjektiv schwerwiegendsten Beeinträchtigungen der Lebensqualität von Tumorpatienten und führt u. a. zu Schlafstörungen, Depressionen und einem reduzierten "Funktionieren" [11]. Diese Angst zu mindern wird durch die aktuellen Nachsorgestrategien noch nicht optimal erreicht [2, 11 -13, 15].…”